Imaging Features and Management of Stress, Atypical, and Pathologic Fractures

Area of Science:

• Radiology
• Orthopedic Surgery
• Bone Physiology

Background:

• Traumatic and atraumatic fractures present with overlapping clinical and imaging findings.
• Atraumatic fractures encompass stress, atypical femoral, and pathologic fractures, each with unique characteristics.
• Bone remodeling and biomechanics are fundamental to understanding fracture etiologies.

Purpose of the Study:

• To review the terminology, etiology, and key imaging features of atraumatic fractures.
• To differentiate between stress, atypical, and pathologic fractures based on imaging.
• To provide imaging criteria for risk stratification of impending pathologic fractures.

Main Methods:

• Review of scientific literature on atraumatic fractures.
• Analysis of bone remodeling pathways and biomechanics.
• Discussion of characteristic imaging findings across fracture types.

Main Results:

• Shared etiologies and key differences between stress, atypical, and pathologic fractures are elucidated.
• Clinically relevant imaging features guiding management are detailed.
• Imaging criteria to distinguish stress from pathologic fractures and risk-stratify neoplasms are presented.

Conclusions:

• Accurate terminology and understanding of imaging features are essential for managing atraumatic fractures.
• Imaging plays a critical role in differentiating fracture types and guiding orthopedic treatment.
• Proximal femur serves as a model for understanding atraumatic fractures throughout the skeleton.